HomeMy WebLinkAboutminor mod 9-14-21BAKERSFIELD FIRE DEPARTMENT
UNDERGROUND STO RAGE TANK Prevention Services
2101 H Street
PERMIT APPLICATION Bakersfield, CA 93301
TO CONSTRUCT -INSTALL NEW TANK {NEW FACILITY}/NEW Phone: 661-326-3979 • Fax: 661-852-2171
TANK INSTALL (EXISTING FACILITY)/MOD-MINOR MOD
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Permit # : 1
TYPE OF APPLICATION: 1 NEW TANK INSTALL/NEW FACILITY NEW TANK INSTALL/EXISTING FACILITY
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STARTING DATE/ 08/18/2021
PROPOSED COMPLETION DATE TBD
FACILITY NAME Jaco #3360 Farrell's Fastrip
EXISTING FACILITY PERMIT #
FACILITY ADDRESS 6401 White Lane
CITY Bakersfield
ZIP CODE 3309
TYPE OF BUSINESS GDF
APN #
TANK OWNER Jaco Hill
PHONE # 661-393-7000
ADDRESS P.O. Box 82515
CITY Bakersfield
ZIP CODE 03380-2515
CONTRACTOR
Confidence UST Services, Inc.
CA LICENSE #
804904
ICC # 9482314
ADDRESS 2200 .Zeus Court
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CITY Bakersfield
ZIP CODE 3308
PHONE # 661-631-3870
SFIELD CITY BUSINESS LICENSE #
WORKMANS COMP # 1308371
INSURER tate Fund
BRIEFLY DESCRIBE THE WORK TO BE DONE:
Replace all (3) Defender Series drop tubes (PN 708592902).
WATER TO FACILITY PROVIDED BY
DEPTH TO GROUND WATER
SOIL TYPE EXPECTED AT SITE
# OF TANKS TO BE INSTALLED
ARE THEY FOR MOTOR FUEL?
YES NO
SPILL PREVENTION CONTROL AND COUNTERMEASURES PLAN ON FILE?
= YES Q NO
THIS SECTION IS FOR STORAGE TANK IDENTIFICATION
TANK #
VOLUME
UNLEADED
REGULAR
PREMIUM
DIESEL
OTHER
1
12K
X
X
2
12K
X
X
3
12K
X
`Tarok Testing Company
NAME OF TESTING COMPANY
PHONE NUMBER
MAILING ADDRESS
NAME OF TESTER
ICC#
THE APPLICANT HAS RECEIVED, UNDERSTANDS, AND WILL COMPLY WITH THE ATTACHED CONDITIONS OF THIS
PERMIT AND ANY OTHER STATE, LOCAL, AND FEDERAL REGULATIONS. THIS FORM HAS BEEN COMPLETED UNDER
PENALTY OF PERJURY, AND TO THE BEST OF MY KNOWLEDGE IS TRUE AND CORRECT.
NAME OF TESTER
Ron Clark
ICC#
9482314
THIS APPLICATION BECOMES A PERMIT WHEN APPROVED
FOR OFFICIAL USE ONLY
DATE APPROVED
APPROVED BY
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